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The use of ibuprofen and acetaminophen for acute headache in the postconcussive youth: A pilot study
Tina Petrelli1,2, Forough Farrokhyar1,3, Patricia McGrath4
1Department of Surgery, McMaster University, Hamilton, Ontario.
Insights
Routine pain relief effectively manages acute postconcussive headaches in children after mild traumatic brain injury. This approach is feasible and helps children return to school faster.
Area of Science:
- Pediatric Neurology
- Traumatology
- Clinical Pharmacology
Background:
- Acute postconcussive headaches are a significant challenge for pediatric mild traumatic brain injury (mTBI) patients.
- Current management lacks evidence-based guidelines, necessitating research into effective interventions.
Purpose of the Study:
- To evaluate the feasibility and efficacy of routine analgesia administration for managing acute postconcussive headaches in children.
- To establish a foundation for evidence-based guidelines in pediatric concussion care.
Main Methods:
- A pilot feasibility study employed a four-arm randomized controlled trial: acetaminophen, ibuprofen, alternating acetaminophen/ibuprofen, and standard care.
- Participants included children aged 8-18 with recent concussion; exclusion criteria involved abnormal neuroimaging or prior concussions.
- Headache diaries tracked headache days, intensity, and return-to-school data over a 1-week follow-up.
Main Results:
- Study recruitment and participant compliance were successful, indicating feasibility.
- Analgesia groups (acetaminophen, ibuprofen, or both) showed significantly reduced headache days, episodes, and intensity compared to standard care.
- Combined ibuprofen and acetaminophen (79.0%) and ibuprofen alone (61.0%) groups had higher return-to-school rates within one week post-injury.
Conclusions:
- Routine administration of analgesics is a feasible and effective strategy for managing pediatric postconcussive headaches.
- Further large-scale randomized controlled trials are warranted to confirm efficacy with extended follow-up and broader patient populations.
Objective:
Acute postconcussive headaches are problematic for children after mild traumatic brain injury. There are no evidence-based guidelines for their management. This pilot study aims to assess the feasibility and efficacy of routine analgesia administration.
Methods:
A four-arm open-label randomized controlled trial pilot/feasibility study was conducted: (i) acetaminophen, (ii) ibuprofen, (iii) alternating acetaminophen and ibuprofen and (iv) a control group. Children and youth 8 to 18 years of age presenting to emergency department with headache within 48 hours of their first concussion were recruited consecutively and sequentially randomized. Children with abnormal neuroimaging, history of previous concussions and bleeding disorder were excluded. A headache survey was administered at recruitment. All participants were provided with standard concussion management education and were also instructed on how to use the headache diary for the 1-week study follow-up period. The diary captures (i) headache days, (ii) number of headaches, (iii) headache intensity and (iv) return-to-school information. Feasibility was assessed based on study recruitment and compliance.
Results:
There were no feasibility concerns with the recruitment and no major compliance issues. Patients on acetaminophen, ibuprofen or both had significantly less headache days, episodes of headache and lower headache intensity than did the standard care group. Patients on both ibuprofen and acetaminophen (79.0%) and on ibuprofen alone (61.0%) were more likely to be back at school 1 week postinjury as compared with the acetaminophen group (33.3%) and the standard care group (21.1%).
Conclusion:
Results showed routine analgesia administration was feasible and effective for postconcussive headache management. A larger full-scale randomized controlled trial is required to further assess the efficacy with longer follow-up, a wider variety of patients and more concussion related outcomes.
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